Because of crowded anatomic arrangement and normal variation in anatomic structures in the human cysto-hepatic area, complete direct visual exposure is vital during open surgery to correctly identify and perform a delicate dissection or the restructuring of organs disposed therein. Prior art solutions included solutions to the basic need of exposing the required areas for surgery, but each had serious problems associated with them as will be hereinafter described.
The more commonly used retractor instruments used for cholecystectomy procedures do not provide an optimum view of the operational area because the device itself obscures the surgeon's direct view into the opening. For example, Ray (U.S. Pat. No. 4,610,243) describes a flat, uniform width force-fulcrum retractor which has at least one "spike" affixed to one end of the band. Since the width is uniform along the body portion, no convenient grip segment is available to aid in the insertion. In use, the spike end is embedded in a suitable bone, the retractor is shaped to the general shape required and the natural resilience of the retractor material provides the necessary force to separate the surrounding tissue from the center of the incision. (See: Ray, col. 1, lines 58-63)
Another retractor is described by Pilling (U.S. Pat. No. 659,182). This retractor has a concave head and neck portion which offers little or no resilience, therefore it is not suitable for reforming to use in a specific incisional opening. In addition, the head and tail portions are bent at about the same angle from the body portion, limiting the applications of use.
Wilbanks (U.S. Pat. No. 3,651,800) teaches a retractor in which the shank portion merges into a bowl or spoon shaped portion. (See: Wilbanks, col. 2, lines 17-19) The head, neck and body portions are concave, cylindrical segments which, as in Pilling, detracts from the resilience force necessary in small incision surgery.
Commonly, cholecystectomy retractors had a wide head and a long, wide neck portion which occupied a large portion of the surgical incision defined when attempting to expose the cysto-hepatic area around the gallbladder. Thus, in order to achieve an adequate viewing area, the instruments required an extraordinarily long incisional opening. This resulted in longer operation times, increased costs of surgery and extended patient recovery times.